March 14, 2022

Disability inclusion is critical to large employers and their broader commitment to diversity, equity and inclusion. Our community of health and well-being leaders has an important role to play by helping employees with disabilities attain their full physical, mental and financial health potential. This article shares an overview of disability and disability inclusion, challenges associated with disability and what employers can do to achieve disability inclusion in health and well-being.

Overview of Disability and Disability Inclusion

One billion people, 15% of the world’s population, experience some form of disability, and in the U.S., one in four adults have a disability.^1,2 The prevalence of people with disabilities is dramatically increasing due to population aging and increases in chronic health conditions, such as diabetes, heart disease, stroke, mental disorders, cancers and respiratory illnesses.³ This means many of your employees will likely experience disability themselves or care for a loved one with a disability during their life.

Contributors to Disability

How we think about disability has changed and is still evolving. It is no longer considered only an individual medical problem in need of treatment. Instead, a disability is the result of a mismatch between a person’s abilities and their environment. While physical, mental and developmental variations may cause impairments, they are not necessarily considered a disability unless environmental and social barriers exist. Reinforcing this point, the World Health Organization (WHO) developed the International Classification of Function, Disability and Health, a framework embraced by all WHO member states. The framework views a person’s level of functioning as an interaction among their health conditions, environmental factors and personal factors:

• Body Functions and Structures: Individual variations in physical, cognitive or mental function or structure.
• Activities and Participation: Limitations or restrictions to life situations as a result of body function or structure.
• Environmental Factors: Physical, social and/or attitudinal factors that serve as barriers or facilitators of one’s ability to function.⁴

It’s important to remember that no definition or model is all-encompassing. Many people with disabilities want to overcome the social and environmental barriers and address the medical conditions and impairments they have.⁵

Health and Well-being Challenges Associated with Disability

Unfortunately, disabled people face many barriers to physical, mental and financial health today. Removing these inequities would be life changing, and in some cases lifesaving, for people with disabilities and their families.

• Health Care Quality: In the U.S., people with disabilities are more likely to receive lower quality care and less preventive care while experiencing a higher incidence of chronic conditions and serious illness than their peers without disabilities.⁹ And globally, people with disabilities are three times more likely to be denied health care.¹ Furthermore, needed accommodations are not always met. For example, many disabled people need longer and more flexible appointment times. Also, a lack of coordination among providers can result in fragmented and duplicative services. Another challenge many face is misdiagnosis, which delays effective treatment. Complicating things further, individuals and parents may seek certain diagnoses due to bias or to qualify for certain benefits. For example, ABA (Applied Behavioral Analysis) therapy is often covered for autism but may not be covered for other intellectual disabilities.
• Health Care Access: A lack of in-network providers specializing in the needs of people with disabilities is a common barrier that causes many to go out-of-network. Distance and transportation can also be barriers to health care access, particularly for those with mobility impairments or those in rural areas. Accessibility of health care facilities varies, and at facilities across the globe, people with disabilities can face inaccessible physical environments, such as stairs, inaccessible doorways, fixed-height examination chair/ tables or unclear signage. Additionally, medical equipment is not always accessible. For example, not all mammography equipment can be lowered to accommodate those who cannot stand.¹⁰ A lack of accessible communications may also be a barrier to accessing health care.
• Unmet Assistive Technology Needs: Globally, only 1 in 10 people in need have access to assistive products and technology due to high costs and a lack of awareness, availability, trained personnel, policy and financing. Assistive devices positively impact health and well-being and health care costs, as well as offer broader socioeconomic benefits.¹¹
• Health Care Cost: Disabled people face five times higher out-of-pocket health care costs and are 50% more likely to experience a catastrophic health expenditure.^12,1 Knowing that, it’s not surprising that they are also three times as likely to not get needed medical care due to cost.¹² Another common challenge for people with disabilities and their families is navigating benefits and coverage, which often requires significant time spent in conversation with insurance plans.
• Stigma and Discrimination: A 2020 study of over 25,000 health care providers revealed that the overwhelming majority were implicitly biased against people with disabilities—an outcome that unfortunately is not surprising to those with disabilities.¹³ This bias contributes to disparities that are often preventable and have nothing to do with a person’s disability. For example, many health care workers assume that people with disabilities are not sexually active or are unfit to be parents, and as a result, they do not receive appropriate reproductive health services and information. It is also common for people with disabilities to experience discrimination from mental health practitioners who believe mental distress is expected due to the person’s circumstances.¹⁴ Stigma and discrimination can also lead to people with disabilities not being appropriately involved in decision-making for their own health.
• Mental Health: Seventy-three percent of people with disabilities identify mental health as a significant concern, compared to 33% of the general population.¹⁵ Having a disability can be a risk factor for mental health conditions. Disabled adults experience mental distress almost five times as often as adults without disabilities.¹⁶ At the same time, a mental illness, such as severe depression or anxiety, can be disabling when it disrupts important day-to-day activities. In fact, mental health is a top reason for short-term disability claims for many large employers.
• Financial Insecurity: Disability and poverty reinforce each another. Poverty can increase the risk of disability because of malnutrition, inadequate access to education and health care, unsafe working conditions, polluted environment and lack of access to safe water and sanitation. On the flip side, disability is associated with a lack of employment and educational opportunities, lower wages and a higher cost of living (more spending goes toward health care services, assistive devices, costlier transportation options, assistance with household tasks like laundry services, special diets, etc.), which can increase the risk of poverty.¹ Households with disabilities also experience income, banking (less likely to have a bank account) and credit (more likely to have unmet need) inequality. Race and ethnicity further these gaps. BIPOC individuals with disabilities have higher poverty rates than those who are White.¹⁷

Employer Actions Toward Disability Inclusion

As we strive to advance health equity, addressing disparities that impact people with disabilities is essential. Large employers can drive change for employees with disabilities, their families and the broader community through benefits, culture and communications.

The need for employer execution or involvement in the practices below will vary across the globe due to differences in publicly available benefits and/or legal requirements.

Accessible, Affordable and High-Quality Health Care

• Provide care coordination benefits and/or health care navigators to help employees and families find top providers, therapists and aides; navigate local services and employer-sponsored benefits; assist with appointments, insurance, medical record transfers and finances; contest insurance bills; ensure shared decision-making throughout the health care experience; offer free expert advice in advocating for and supporting their needs or their loved ones and more.
• Ensure that employees with disabilities are not denied insurance and/or coverage to the same health care as other employees.
• Provide a means, such as a hotline, for employees to report discrimination and mistreatment.
• Work with health plans to ensure that the assessment of medical necessity required for coverage is made in the context of the individual’s overall health condition and takes into account the unique needs of those with disabilities.
• Influence networks and vendors providing health care and well-being services to incorporate disability inclusion trainings for all providers. Trainings should address the stigma and incorrect assumptions associated with disabilities and proper care accommodations.
• Expand benefits coverage for higher prevalence needs of those with disabilities, such as coverage for hearing aids, vision care and assistive devices.
• Provide access to preventive screenings, early diagnosis and treatment and encourage individuals to take advantage of them, when possible. Early diagnosis and intervention help ensure that people with disabilities can reach their full potential and can lead to improvements in physical, cognitive, emotional and social functioning.
• Provide coverage, financial assistance and/or connect employees with government and community resources for services and assistive devices needed for engagement in health care, work and life (e.g., mobility aids, hearing aids, prostheses, screen readers, voice recognition programs, interpreter services, smart home assistants, stair-climbing power chairs, smart watches).
• Expand access and accessibility to telehealth care. Telehealth can improve access to specialists and eliminate barriers associated with transportation and the physical environment. However, telehealth may not always be the appropriate solution for a patient’s needs, and the telehealth itself will need to be accessible. For example, Deaf patients may need video interpretation services.
• Provide second opinions services.
• Provide coverage for Centers of Excellence (COEs). COEs should be evaluated for features like data collection, patient outcomes, physician performance, cultural competence and relevant condition management.
• Provide benefits that address the indirect costs associated with accessing health care, such as transportation support.
• Provide a means for employees to find and choose mental health providers who are culturally competent in supporting those with disabilities and/or their families.
• Provide information in your navigation tools about providers equipped to handle the unique needs of people with disabilities and encourage the use of virtual health tools and programs available to disabled employees.
• Tier premiums, account contributions and/or deductibles based on salary.
• Offer a non- high-deductible health plan (HDHP) with low premiums, low copays and no-cost preventive care.
• Encourage the involvement of family members and caregivers in medical consultations when appropriate.
• Empower people with disabilities (and their caregivers) to maximize their health and self-advocacy by providing information, training and peer support.

Accommodations, Disability and Other Key Benefits

• Audit all health and well-being benefits, initiatives and communications through a disability lens.
• Offer short- and long-term disability benefits (best—at no cost to employees) in the U.S., and globally review publicly available and employer-sponsored medical and disability leaves and ensure consistency across the globe in access to time away for employees. Provide information and guidance to help employees understand disability benefits and their interaction with other leaves and benefits.
• Provide reasonable and effective accommodations. When an accommodation is not obvious, a best practice is to engage in a flexible, interactive process, often involving conversations between the employee, their supervisor and HR and recommendations from health care providers to determine the most appropriate accommodation(s).
• Centralize the cost of employee accommodations to remove budget concerns from department leaders and managers.
• Provide training for all managers on the Americans with Disabilities Act (ADA) and other regulatory processes and requirements.
• Provide a robust suite of mental health services, including tailored offerings for employees with disabilities and caregivers.
• Provide employees with paid sick and caregiver leaves.
• Provide tailored financial and legal supports (e.g., assistance with special needs trust).
• Provide a robust suite of caregiver benefits, from a dedicated care coordinator or access to diagnostic tools for early condition identification.

Workplace Culture, Communications and Physical Spaces

• Embrace disability inclusion as part of the company’s overall diversity, equity and inclusion strategy.
• Commit to universal design principles to ensure maximum access and understanding when developing, adding or updating buildings, products, services and communications. For example, when leasing new buildings, ensure that accessible design features are present (e.g., automatic doors, spiral ramps, accessible elevators, signage and wayfinding tools, such as textured surfaces, for those with sensory impairments). For communications, universal design may include avoiding using only images to communicate information about an event, adding alt text, using large fonts and ensuring good color contrast and spacing.
• Offer training on disability inclusion, include disability inclusion information in new hire orientations and support awareness of disability issues.
• Create a safe environment for people to disclose their disabilities and/or caregiving role and leverage their experiences and perspectives.
• Ensure that employees with disabilities have access to and are aware of benefits and resources that are specific to and/or tailored for their needs.
• Maximize flexible work options, such as flexible schedules, remote/hybrid work and part-time work.
• Establish a means, either internally or through a vendor, to listen to the experiences of people with disabilities, assist with individual cases as needed, and identify systemic issues for intervention.
• Provide a means for employees to request accommodations for internal events and meetings, including all well-being activities.
• Provide corporate support for a disability-related Employee Resource Group (ERG) and partner with ERGs to promote benefits and learn about benefit gaps for people with disabilities.
• Increase representation of people with disabilities at all levels of the organization (best—have a company-wide external hiring goal for people with disabilities).
• Utilize the employee engagement and/or benefits survey to identify differences in the employee experience for those with disabilities and those without.
• Provide philanthropic support to external disability-related events or organizations and support legislative efforts that promote disability inclusion.

More Topics

Articles & Guides Diversity, Equity, Inclusion & Belonging (DEIB) Health Equity Plan Design & Administration